The biggest concerns facing ASC owners and operators today include physician recruitment, reimbursements and consolidation.
At the Becker's ASC 25th Annual Meeting – The Business and Operations of ASCs, industry experts gathered for a keynote panel discussing the current state of the ASC industry. Scott Becker, publisher of Becker's Healthcare, moderated the panel, which took place on Oct. 19.
The panel featured:
• Vice Chairman of the Department of Orthopedic Surgery and Chief of Sports Medicine at Roanoke, Va.-based Carilion Clinic Thomas K. Miller, MD
• Trumbull, Conn.-based Orthopedic & Sports Medicine Center Partner Michael Redler, MD
• Partner at Merritt Healthcare Advisors Matthew Searles
• COO of ASCOA Susan Kizirian
• CEO of Deerfield, Ill.-based Surgical Care Affiliates Tony Kilgore.
Here are key quotes on the top themes from the panel:
Mr. Searles on consolidation: "I think there is more of an emphasis now for independent centers to align with larger systems as these studies and pressures take hold. With the exception of a few different markets, out-of-network doesn't seem to exist anymore as a viable strategy. In terms of facilities that are attractive to providers, I think a lot of the hospital systems understand that they have to really provide care across the continuum in a way that is cost-effective."
Mr. Kilgore on understanding reimbursement data: "We find that physicians appreciate the application of data in scorecard format – tracking performance this way really resonates with them. It is critical for physicians to understand cost versus reimbursement and to be able to have that conversation with every individual at the center. It also helps in contract negotiations when you have an in-depth understanding of costs and reimbursements.
Mr. Kilgore on the future of independent physicians: "One of the biggest challenges that we see as an industry is the decline of independent physicians. Many primary care physicians are seeking employment with larger groups vs. independent practices. While surgical specialists are more willing to embrace the independent structure, it’s clear that they need resources and support to better understand the economic benefits of this practice model. That’s why we are doing outreach, providing educational material and conducting trainings to engage physicians who are curious about ASCs very early in their careers. We are also looking at the risks faced by five-to-seven-man physician groups and their ability to maintain their independence. Across the country, we are seeing smaller groups merge into larger groups and align with health systems. We have invested in a new division to aggregate physicians and offer them our solutions."
Dr. Redler on recruiting young physicians: "We are getting to the point where some of the physicians coming out of residency and fellowship are millennials and there are some that want to migrate toward a 9 a.m. to 5 p.m. type of job, a healthcare system job with limited responsibilities in terms of business. The reality is, that might not be the best partner to have because that's not going to be the guy or woman that wants to go the extra mile and put in the extra effort and time. What we are finding is that we have to find the right individual and we will probably have to over pay them to start off with so we can determine whether the relationship will become longer. Then you want to get them involved in the surgery center."
Dr. Miller on going from an independent group to becoming part of a larger organization: "The biggest issue for us is we came into our merger with Carilion Clinic with not just an expectation but a mandate to improve care. We came in with 20-plus year history of private practice, and we were brought in to maintain that same approach to things. That is a bit unique. It took a long time to develop that relationship, but it allowed us to recruit as if we were independent. We tripled the size of our group in the past 10 years, but it's hard to find the right person."
Dr. Miller on when to offer new physicians partnership: "I would advise that someone know there is a time frame that they know they will have an investment. For us, in two to three years you know whether or not someone is going to be a fit and what their profile is going to be."
Ms. Kizirian on when to offer new physicians partnership: "We can usually tell in three or four months. That is what we're looking at. Sometimes they have been there, and you have to rely on your partners in the community to tell you about that person and if they are a good fit for the partnership. But if they come in and schedule cases and we can immediately see how they utilize supplies and implants, how fast they are, all the things that we look at to see how they could positively impact the surgery center on the financial side, [then a partnership is a possibility]. The physicians in the surgery center know what is going on, how the surgeon operates, and they know what's going on."